School-Age Children with Perinatally Acquired HIV Infection: Medical and Psychosocial Issues in a Philadelphia Cohort

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Abstract
With the advent of highly active antiretroviral therapy (HAART), children with perinatally acquired human immunodeficiency virus (HIV) are living into their school-age years and adolescence. This study was designed to explore some of the medical, educational, and psychosocial aspects of these older children's lives. A retrospective chart review of 85 HIV-infected, school-age patients was conducted to obtain demographic and clinical data. Fifty-four of these patients and their caregivers were interviewed regarding school-related issues. Although 50% of the children had experienced severe symptoms (Centers for Disease Control [CDC] class C) related to their HIV infection, their mean CD4 count at the time of the study was 722 cells per microliter, and 40% had an undetectable (<40 copies per milliliter) viral load. More than two thirds of the patients were not hospitalized over the course of the year. The mean developmental quotient (DQ) for the group was 85; 12% of the children had a DQ below 70. Nearly all (85%) of the children were attending public school, and 76.5% were in the appropriate grade level for their age. More than half (53%) required some special services while in school. Forty-three percent of the children had been told their HIV status, and the average age at disclosure was 9 years. School employees had been told the child's diagnosis in 23% of the cases. As the perinatally acquired HIV-infected population ages, health care providers must be cognizant of the range of issues, both medical and social, confronting these children.